Surakanti, Mahender Reddy
Surakanti, Mahender Reddy is an sole proprietor health care provider with primary practice located at 7806 W Jefferson Blvd Ste C , Fort Wayne IN 46804. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Surakanti, Mahender Reddy can be contacted via phone (260) 203-4188.Contact Information
Primary practice address
7806 W Jefferson Blvd Ste C
Fort Wayne IN 46804
Phone: (260) 203-4188
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 01057700A | Indiana |
Profile Details
| NPI number | 1417940909 |
|---|---|
| LBN Legal business name | Surakanti, Mahender Reddy |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 30th, 2005 |
| Last updated | May 25th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417940909 | NPPES |
| Indiana | MEDICAID | 200442540A |
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